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• Feasibility of Telemonitoring in improving health of tribal’s
  Sirin Khan, Tapas Chakma, Kritika Singh and Suyesh Shrivastava*
  Published on: 31 May 2023

• Published on: 31 May 2023

  Feasibility of Telemonitoring in improving health of tribal’s

  • Sirin Khan, Scientist B ICMR-NIRTH, Jablapur
  • Other Contributors:
    • Tapas Chakma, Scientist G
    • Kritika Singh, Scientist B
    • Suyesh Shrivastava*, Scientist C

  Telemonitoring is an emerging field which uses information technologies to transmit information on patient’s health to the selected healthcare facility. We have read the article by Gijsbers et al al with great interest [1] In addition to these arguments, we would like to express some vital issues regarding the viability of telemonitoring in enhancing triabl health. The effectiveness of telemonitoring in managing health issues was tested in a small number (and very few among tribals) of randomized control trials because it is a new field. These trials found that telemonitoring is beneficial in controlling chronic illness conditions. Telemonitoring has the potential to help with the management of chronic illnesses like hypertension since it enables continuous monitoring of vital signs, which lowers the number of trips to medical facilities [2].
  TASHMINH-4 trial study proved to be a milestone in establishing the effectiveness in the management of Telemonitoring in chronic condition like hypertension. The study done by Richard McManus and colleagues, shows that self-monitoring of blood pressure with Telemonitoring used by general practitioner in poorly controlled individuals has significantly help in improving control over the blood pressure. This study emphasize that self-monitoring of blood pressure by individual helps in better control over of high blood pressure [3][4].
  Telemonitoring provides a platform which makes healthcare services accessible through home...

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  Telemonitoring is an emerging field which uses information technologies to transmit information on patient’s health to the selected healthcare facility. We have read the article by Gijsbers et al al with great interest [1] In addition to these arguments, we would like to express some vital issues regarding the viability of telemonitoring in enhancing triabl health. The effectiveness of telemonitoring in managing health issues was tested in a small number (and very few among tribals) of randomized control trials because it is a new field. These trials found that telemonitoring is beneficial in controlling chronic illness conditions. Telemonitoring has the potential to help with the management of chronic illnesses like hypertension since it enables continuous monitoring of vital signs, which lowers the number of trips to medical facilities [2].
  TASHMINH-4 trial study proved to be a milestone in establishing the effectiveness in the management of Telemonitoring in chronic condition like hypertension. The study done by Richard McManus and colleagues, shows that self-monitoring of blood pressure with Telemonitoring used by general practitioner in poorly controlled individuals has significantly help in improving control over the blood pressure. This study emphasize that self-monitoring of blood pressure by individual helps in better control over of high blood pressure [3][4].
  Telemonitoring provides a platform which makes healthcare services accessible through home or other remote area. It as well aids in providing “point of care” of care service for chronic condition [4].
  As Telemonitoring has the potential to serve large group of population, population residing in the remote areas, vulnerable population like geriatrics population [5].
  The applications of Telemonitoring in hypertension management need to be focused, as India accounts for largest tribal population of the world. According to census 2011, approximately 67.8 million tribal population spread across India and about 90% resides in rural area. Tribal population considered to be vulnerable in terms of poor health indicator as compare to general population which can be influenced by their low literacy level, poverty and their scattered geographical distribution. Due to which these population has little access to healthcare services, causes high burden of disease morbidity and mortality. A report by Tribal health expert committee headed by Dr Abhay Bang, , there is a shift in disease trend from communicable to non-communicable diseases which will raise the demand for Telemonitoring for monitoring and management of chronic condition [6].
  The study by Chakma et al (2017), found the burden of Hypertension was approx. 30% among the tribal population of central India. The study shows that, 28.2% of males and 23.6% of females had either stage-I or stage-II hypertension [7]. Also study had done by Meshram et al (2013) shows the increasing burden of hypertension among tribal population of Maharashtra [8]. A Meta-Analysis done by Rizwan et al (2014), illustrates that there is an increasing burden of hypertension among the tribal people [9].
  These are the marginalized population which usually resides in the remote areas, if these population to be self-monitored with Telemonitoring by simple free text SMS in local language or a designated nurse trained with the mobile-health tool at the nearest facility will be given driver’s seat in monitoring of blood pressure of the local population through Telemonitoring and antihypertensive dose adjusted by General Physician. Similar to TASHMIN-4 trial, suggestive of better control over high blood pressure can be achieved in Indian context with limited resources a large geographical population can be covered.

  How it be beneficial if implemented at tribal areas:
  • Telemonitoring helps in diagnosing new hypertensive cases, which will eventually add on increasing control over high blood pressure.
  • Due to low literacy level among tribal’s, Telemonitoring can be used as a tool for screening of disease using specific symptom.
  • Telemonitoring allows early detection of chronic disease conditions which in turn reduces complications and financial burden.
  • Telemonitoring can also be beneficial for the aging population, as these population had to face challenges while assessing to nearest health facilities.

  References

  1. Gijsbers H, Feenstra TM, Eminovic N, et alEnablers and barriers in upscaling telemonitoring across geographic boundaries: a scoping reviewBMJ Open 2022;12:e057494. doi: 10.1136/bmjopen-2021-057494
  2.Hanley J, Pinnock H, Paterson M, McKinstry B. Implementing telemonitoring in primary care: learning from a large qualitative dataset gathered during a series of studies. BMC family practice. 2018 Dec;19(1):118.
  3. McManus RJ, Mant J, Franssen M, et al. Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): unmasked randomised controlled trial.Lancet 2018; published online Feb 27. http://dx.doi.org/10.1016/S0140-6736(18)30309-X.
  4. Rietzschel ER, De Buyzere ML. Hypertension: time for doctors to switch the driver's seat?. The Lancet. 2018 Mar 10;391(10124):914-6.
  5. Hovey L, Kaylor MB, Alwan M, Resnick HE. Community-based telemonitoring for hypertension management: Practical challenges and potential solutions. Telemedicine and e-Health. 2011 Oct 1;17(8):645-51.
  6. Tribal Health Expert Committee report [Internet]. Tribal health in India- Bridging the gap and a roadmap for the future; 2018 [Cited 2019 August 2]. Available form:
  https://mohfw.gov.in/sites/default/files/Tribal%20Health%20Expert%20Comm...
  7. Chakma T, Kavishwar A, Sharma RK, Rao PV. High prevalence of hypertension and its selected risk factors among adult tribal population in Central India. Pathogens and global health. 2017 Oct 3;111(7):343-50.
  8. Meshram II, Laxmaiah A, Mallikharjun RK, Arlappa N, Balkrishna N, Reddy CG. Prevalence of hypertension and its correlates among Adult Tribal Population (≥ 20 years) of Maharashtra state, India. Int J Health Sci Res. 2014;4(1):130-9.
  9. Rizwan SA, Kumar R, Singh AK, Kusuma YS, Yadav K, Pandav CS. Prevalence of hypertension in Indian tribes: a systematic review and meta-analysis of observational studies. PLoS one. 2014 May 5;9(5):e95896.

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  Conflict of Interest:
  None declared.

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